Study Backs Health-Promoting Text Messages

Sending electronic text messages that not only reminded parents that their children needed a second influenza vaccine dose but also contained other health information was more effective than plain reminders in getting the kids to come in for the booster, researchers reported.

Children whose families received the informational text reminders had a second dose at some point during the flu season of 72.7%, compared with 57.1% among those who were given written reminders (P=0.003), according to Melissa Stockwell, MD, MPH, of Columbia University Medical Center in New York City, and colleagues.

Among families who received simpler reminders focusing only on the second dose, compliance rates were 66.7%.

The inclusion of health literacy-promoting information may have helped parents become more proactive and timely in getting their children vaccinated, the researchers wrote in Pediatrics.

"Text message programs allow for healthcare providers to care for their patients even when they are not in front of them in the office, somewhat like a modern day 'house call,'" said Stockwell.

Study Details

Researchers performed a randomized, controlled trial at three community-based pediatric clinics in New York City during the 2012-2013 influenza season. The study enrolled 660 families of children 6 months to 8 years old who had received their first influenza vaccine dose at one of the study sites and who needed a second dose, either because they had not received two doses of the vaccine since July 2010 or had not received two previous seasonal vaccinations plus the 2009 H1N1 vaccine.

All families received a written reminder about when to come in for their child's second dose of the vaccine, and were then randomly assigned into one of three groups: those who received the written reminder only, those who received a conventional text message about the needed second dose, and those who received the more elaborate educational text message. Both text message groups received five messages in total: three before the next dose was due, one the day after the dose was due, and the last one 2 weeks after the dose was due.

Educational text messages helped improve vaccine compliance, even when vaccines were overdue. Families receiving educational text message reminders were more likely to receive a second dose of the influenza vaccine within 2 weeks of the due date.

Compliance rates were lower when restricted to children receiving the second dose within 42 days of the first dose as recommended: 43.5% among those receiving the informational text messages, 33.9% for those getting the simpler text messages, and 25.6% for those receiving only written information (P<0.001).

Limitations of the study included its size and composition. Almost 90% of participants were Latino and nearly all (97%) had public insurance, such as Medicaid or the State Children's Health Insurance Program.

"[A] next step would be to assess the impact of these text message vaccine reminders in other populations," Stockwell said.

Hofstetter receives support from the Pfizer Medical Education Group for a different investigator-initiated study.

Stockwell is a co-investigator, but receives no financial support.

Hofstetter also received support through the Investigator-Initiated Studies Program of Merck, Sharp and Dohme for a different study.

The other authors indicate they have no financial relationships relevant to this article to disclose.

The authors have indicated they have no potential conflicts of interest to disclose.